HSP Fusion Protein with Anti-Chemorepellant Agent for Treatment of Cancer

ABSTRACT

This disclosure is directed to immune treatment of a disease (e.g., cancer) using a fusion protein in combination with an anti-chemorepellant agent. In particular, the fusion protein comprises an antigen-binding domain (e.g., an antibody or antibody fragment) and a stress protein domain.

STATEMENT OF PRIORITY

This application claims the benefit of U.S. Provisional Application Ser. No. 62/385,877, filed Sep. 9, 2016, the entire contents of which are incorporated by reference herein.

STATEMENT OF GOVERNMENT SUPPORT

This invention was made with government support. The U.S. Government has certain rights in this invention.

FIELD OF THE INVENTION

This disclosure is directed to immune treatment of a disease (e.g., cancer) using a fusion protein in combination with an anti-chemorepellant agent. In particular, the fusion protein comprises an antigen-binding domain (e.g., an antibody or antibody fragment) and a stress protein domain.

BACKGROUND OF THE INVENTION

Immunotherapy is a promising treatment for cancers as well as other diseases. Immunotherapy treats disease by inducing, enhancing, augmenting, or suppressing an immune response in a patient.

One aspect of immunotherapy seeks to increase the patient's own immune response to disease-associated antigens. For example, U.S. Pat. Nos. 8,143,387 and 7,943,133 describe fusion proteins with an antibody portion fused to a stress protein that are effective at eliciting T cell-mediated immune response.

There is a need for improved immunotherapy to enhance a patient's immune response to cancers and other diseases.

SUMMARY OF THE INVENTION

This invention is directed to immune treatment of cancer using a fusion protein in combination with an anti-chemorepellant (i.e., an anti-fugetactic) agent. In particular, the fusion protein comprises an antigen-binding domain (e.g., an antibody or antibody fragment) and a stress protein domain.

Stress proteins are very efficient at presenting antigens to antigen-presenting cells and provoking a T cell response. They have been particularly effective at eliciting cell mediated immune and humoral immune responses by this pathway.

The fusion protein binds to antigens with high affinity, is highly immunogenic, exhibits MHC class I priming, provokes a T cell response and is able to be produced in non-mammalian systems such as E. coli. The fusion protein is thus suitable for use as a highly immunogenic vaccine for the prevention or treatment of a number of diseases, including cancer. Non-limiting examples of fusion proteins can be found in U.S. Pat. Nos. 8,143,387 and 7,943,133 and PCT Application Number PCT/US2017/021911, each of which is incorporated herein by reference in its entirety.

Some tumor cells secrete concentrations of chemokines that are sufficient to repel immune cells from the site of a tumor, thus creating a “fugetactic wall” or “chemorepellant wall” around the tumor. The chemorepellant wall reduces the immune system's ability to target and eradicate the tumor. For example, repulsion of tumor antigen-specific T-cells, e.g., from a tumor expressing high levels of CXCL12 or interleukin 8 (IL-8), allows the tumor cells to evade immune control. Anti-chemorepellant agents inhibit the chemorepellant activity of tumor cells and allow the patient's immune system to target the tumor. Anti-chemorepellant agents and the systemic delivery of anti-chemorepellant agents are known in the art (see, for example, U.S. Patent Application Publication No. 2008/0300165, incorporated herein by reference in its entirety).

Without being bound by theory, it is believed that the antigen-binding domain of the fusion protein will bind to the target (e.g., cancer cell), and the stress protein domain will induce maturation of antigen-presenting cells (e.g., dendritic cells), resulting in a T cell response to the target. In combination, the anti-chemorepellant agent will inhibit the chemorepellant activity of the target with regard to the immature antigen-presenting cells and/or T-cells, such that the immune cells are able to penetrate the “chemorepellant wall” and access the target. In some embodiments, the combination results in additive or synergistic effects.

In one embodiment, this invention relates to a method for treating a cancer in a patient wherein the cancer expresses chemorepellant properties, the method comprising administering to the patient: a) an effective amount of a fusion protein which protein comprises a cancer cell binding component and a stress protein component, wherein the cancer cell binding component binds to the cancer cell and the stress protein component activates dendritic cells, leading to the generation of CD3 positive T-cells that target tumor antigens; and b) concurrently administering to the patient an effective amount of an anti-chemorepellant agent; wherein the combination of the fusion protein and the anti-chemorepellant agent treat the cancer.

Anti-chemorepellant agents may include, without limitation, molecules that inhibit expression of CXCL12 or CXCR4 or CXCR7 (e.g., antisense or siRNA molecules), molecules that bind to CXCL12 or CXCR4 or CXCR7 and inhibit their function (e.g., antibodies or aptamers), molecules that inhibit dimerization of CXCL12 or CXCR4 or CXCR7, and antagonists of CXCR4 or CXCR7. In one embodiment, the inhibitor of CXCL12 signaling is a CXCR4 antagonist. In one embodiment, the anti-chemorepellant agent is AMD3100 or a derivative thereof, AMD11070 (also called AMD070), AMD12118, AMD11814, AMD13073, FAMD3465, C131, BKT140, CTCE-9908, KRH-2731. TC14012, KRH-3955, BMS-936564/MDX-1338, LY2510924, GSK812397, KRH-1636, T-20, T-22, T-140, TE-14011, T-14012, TN14003, TAK-779, AK602, SCH-351125, tannic acid, NSC 651016, thalidomide, GF 109230X, an antibody that interferes with dimerization of a chemorepellant chemokine, such as CXCL12, or an antibody that interferes with dimerization of a receptor for a chemorepellant chemokine, such as CXCR4 or CXCR7. In one embodiment, the anti-chemorepellant agent is AMD3100 (1,1′-[1,4-phenylenebis(methylene)]bis [1,4,8,11-tetraazacyclotetradecane]; plerixafor). AMD3100 is described in U.S. Pat. No. 5,583,131, which is incorporated by reference herein in its entirety. In one embodiment, the anti-chemorepellant agent is a CXCR7 antagonist. The CXCR7 antagonist can be but is not limited to CCX771, CCX754, or an antibody that interferes with the dimerization of CXCR7. In certain embodiments, the anti-chemorepellant agent is not an antibody. In certain embodiments, the anti-chemorepellant agent is not a heparinoid. In certain embodiments, the anti-chemorepellant agent is not a peptide.

In one embodiment, the anti-chemorepellant agent and the fusion protein are co-administered. In one embodiment, the anti-chemorepellant agent is administered prior to administration of the fusion protein. In one embodiment, the anti-chemorepellant agent is administered after administration of the fusion protein.

In one aspect, the stress protein component comprises a heat shock protein or fragments and/or modified sequences thereof. In one embodiment, the heat shock protein is HSP70 or an immune activating fragment and/or modified sequence thereof. In one embodiment, the HSP70 or the immune activating fragment and/or modified sequence thereof is from Mycobacterium tuberculosis.

The cancer cell binding component may be any antibody or other molecule that recognizes a cancer cell of interest. In one aspect, the cancer cell binding component is a single chain antibody. In one aspect, the cancer cell binding component is a variable domain fragment. In one aspect, the cancer cell binding component is a Fab portion of an antibody.

In one aspect, the cancer cell binding component is specific for a cancer antigen (e.g., a tumor-specific antigen or a tumor-associated antigen). The cancer antigen may be any identifiable cell surface antigen that is expressed by a cancer of interest. In one embodiment, the cancer antigen is mesothelin, alphafetoprotein, CEA, CA-125, MUC-1, Her2Neu, ETA, NY-ESO-1, VEGF, VEGFR1, VEGFR2, PSMA, prostate specific antigen, HPV17E7, mutant p53, surviving, ras, MAGE, gp100, tyrosinase, WT1, PR1, folate-binding protein, CA-19-9, FAP, G250, or A33.

In one embodiment, the antibody is specific for mesothelin. Fusion proteins that recognize and bind to mesothelin are described, for example, in U.S. Pat. No. 7,943,133, which is incorporated herein by reference in its entirety. Additional fusion proteins are described in PCT Application No. PCT/US2017/021911, which is incorporated herein by reference in its entirety.

In one embodiment, the fusion protein comprises a peptide having at least 85% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. Preferably, the fusion protein retains the ability to produce activated APCs having tumor-specific antigens on the APC cell surface. In one embodiment, the fusion protein comprises the peptide sequence of SEQ ID NO.: 1. In one embodiment, the fusion protein comprises the peptide sequence of SEQ ID NO.: 2. In one embodiment, the fusion protein comprises the peptide sequence of a fusion protein sequence disclosed in PCT Application Number PCT/US2017/021911.

The methods and compositions described herein may be used to treat any cancer, e.g., any cancer that can be injected with the fusion protein. In some embodiments, the cancer exhibits a chemorepellant effect. In one embodiment, the chemorepellant effect is mediated by overexpression of CXCL12 or other chemorepellant chemokine by the cancer. In one embodiment, the method further comprises selecting a patient having a cancer that exhibits a chemorepellant effect.

In one embodiment, the cancer comprises breast cancer, leukocytic cancer, liver cancer, ovarian cancer, head and neck cancer, bladder cancer, prostatic cancer, skin cancer, bone cancer, brain cancer, leukemia cancer, lung cancer, colon cancer, anal cancer, CNS cancer, melanoma cancer, renal cancer, cervical cancer, esophageal cancer, testicular cancer, splenic cancer, kidney cancer, lymphatic cancer, pancreatic cancer, stomach cancer or thyroid cancer. In one embodiment, the cancer is mesothelioma. In one embodiment, the cancer is a hematological malignancy. Hematological malignancies include cancers of the blood, bone marrow, lymph, and lymphatic system, including, but not limited to, leukemias, lymphomas, and myelomas. In one embodiment, the cancer is a human papilloma virus (HPV)-positive cancer.

In one embodiment, the fusion protein is administered via injection. In one embodiment, the fusion protein is injected directly into the tumor. In one embodiment, the fusion protein is injected into a body cavity containing a tumor or into a blood vessel feeding a tumor. In one embodiment, the fusion protein is systemically administered.

In one embodiment, the anti-chemorepellant agent is administered via injection. In one embodiment, the anti-chemorepellant agent is administered directly to the tumor or proximal to the tumor. In one embodiment, the anti-chemorepellant agent is injected into a body cavity containing a tumor or into a blood vessel feeding a tumor. In one embodiment, the anti-chemorepellant agent is administered systemically.

In one aspect, this invention relates to a pharmaceutical composition comprising a fusion protein and an anti-chemorepellant agent. In one embodiment, the composition further comprises antigen-presenting cells. In one embodiment, the antigen-presenting cells are dendritic cells.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows the peptide sequence of VIC-007 (SEQ ID NO.: 1) and VIC-008 (SEQ ID NO.: 2).

FIG. 2A indicates intraperitoneal ovarian tumor growth using bioluminescence signals for each treatment (saline, VIC-007, or VIC-008) at weeks 0 (W0), 1 (W1), 2 (W2), 3 (W3), 4 (W4) and 5 (W5).

FIG. 2B is a graphical representation of the tumor growth shown in FIG. 2A.

FIG. 3 shows percent survival of the mice inoculated with ovarian cancer cells, after administration of saline, VIC-007, or VIC-008.

FIG. 4 shows the treatment protocol for tumor inoculation (mesothelioma) followed by administration of saline, VIC-008 alone, AMD3100 alone, or VIC-008 with AMD3100.

FIG. 5 shows percent survival of the mice inoculated with mesothelioma cancer cells, Luc-40L, after administration of saline, VIC-008 alone, AMD3100 alone, or VIC-008 with AMD3100.

FIG. 6 shows percent survival of the mice inoculated with mesothelioma cancer cells, Luc-AE17, after administration of saline, VIC-008 alone, AMD3100 alone, or VIC-008 with AMD3100.

FIGS. 7A-7D show tumor growth and mice survival in different treatment groups. All the intraperitoneal tumors were collected at day 7 after the last treatment and weighed in 40L (n=10) (A) and AE17 (n=10) (B) mice. The survival of 40L (n=12) (C) and AE17 (n=12) (D) tumor bearing mice. Numbers on X axis represented days of mouse survival after inoculation of tumor cells into mice. NS, not significant, *P<0.05, ** P<0.01, ***P<0.001 and ****P<0.0001. Data were presented as mean±SEM.

FIGS. 8A-8F show VIC-008 facilitates lymphocyte infiltration. (A) Gating strategy for infiltrated lymphocytes. The proportion of CD8⁺ T cells in total live splenocytes in 40L (n=6) (B) and AE17 (n=5) (C) mice. The proportion of CD8⁺ T cells in total live cells in lymph nodes of AE17 mice (n=5) (D). The proportion of CD8⁺ T cells in total live cells in tumors of 40L (n=6) (E) and AE17 (n=5) (F) mice. *P<0.05, **P<0.01 and ***P<0.001. Data are presented as mean±SEM.

FIGS. 9A-9D show VIC-008 promoted CD8⁺ T-cell IFN-γ secretion. (A) Representative dot plots of IFN-γ secreting cells in different treatment groups. The proportion of IFN-γ secreting cells in CD8⁺ T cells in spleens of 40L (n=6) (B) and AE17 (n=5) (C) mice. The proportion of IFN-γ secreting cells in CD8⁺ T cells in lymph nodes of AE17 mice (n=5) (D). **P<0.01 and ***P<0.001. Data are presented as mean±SEM.

FIGS. 10A-10E show AMD3100 decreased PD-1 expression on CD8⁺ T cells. The proportion of PD-1-expressing cells in CD8⁺ T cells in spleens of 40L (n=6) (A) and AE17 (n=5) (B) mice. The proportion of PD-1-expressing cells in CD8⁺ T cells in lymph nodes of AE17 mice (n=5) (C). The proportion of PD-1-expressing cells in CD8⁺ T cells in tumors of 40L (n=6) (D) and AE17 (n=5) (E) mice. *P<0.05 and **P<0.01. Data are presented as mean±SEM.

FIGS. 11A-11F show AMD3100 reduced Tumor-infiltrating T's. The proportion of T_(reg) in total live splenocytes in 40L (n=6) (A) and AE17 (n=5) (B) mice. The proportion of T_(reg) in total live cells in lymph nodes of AE17 mice (n=5) (C). The ratio of CD8⁺ T cells to T_(reg) in lymph nodes of AE17 mice (n=5) (D). The proportion of T_(reg) in total live cells in tumors of 40L mice (n==6) (E). The ratio of CD8 T cells to T_(reg) in tumors of 40L mice (n=6) (F). *P<0.05, **P<0.01, ***P<0.001 and ***P<0.0001. Data are presented as mean±SEM.

FIGS. 12A-12E show AMD3100 reprogrammed T_(reg) to helper-like cells. The ratio of CD25⁻ to CD25⁺ cells in CD4⁺ Foxp3⁺ T-cell population in tumors of 40L (n=6) (A) and in lymph nodes of AE17 (n=5) (B) mice. Representative density plots of IL-2⁺ CD40L⁺ cells in Foxp3⁺ CD25⁻ T_(reg) population in different treatment groups (C). The proportion of IL-2⁺ CD40L+ cells in Foxp3⁺CD25⁻ T_(reg) population in tumors of 40L (n=6) (D) and in lymph nodes of AE17 (n=5) (E) mice. *P<0.05, **P<0.01, ***P<0.001 and ****P<0.0001. Data are presented as mean±SEM.

FIGS. 13A-13F show AMD3100-driven T_(reg) reprogramming required TCR activation. (A) Representative dot plots of Foxp3⁺ CD25⁻ and Foxp3⁺ CD25⁺ population with or without AMD3100 treatment under no anti-CD3/CD28 stimulation (A) and statistical difference was analyzed using unpaired r-test with Welch's correction (n=4) (B). Representative dot plots of Foxp3⁺ CD25⁺ and Foxp3⁺ CD25⁺ population with or without AMD3100 treatment under anti-CD3/CD28 stimulation (C) and statistical difference was analyzed using unpaired t-test with Welch's correction (n=4) (D). Representative density plots of IL-2⁺ CD40L⁺ cells in Foxp3⁺ CD25⁻ T_(reg) population with or without AMD3100 treatment under anti-CD3/CD28 stimulation (E) and statistical difference was analyzed using unpaired t-test with Welch's correction (n=4) (F). Data are presented as mean±SEM.

DETAILED DESCRIPTION

After reading this description, it will become apparent to one skilled in the art how to implement the invention in various alternative embodiments and alternative applications. However, not all embodiments of the present invention are described herein. It will be understood that the embodiments presented here are presented by way of an example only, and not limitation. As such, this detailed description of various alternative embodiments should not be construed to limit the scope or breadth of the present invention as set forth below.

Before the present invention is disclosed and described, it is to be understood that the aspects described below are not limited to specific compositions, methods of preparing such compositions, or uses thereof as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular aspects only and is not intended to be limiting.

Definitions

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.

In this specification and in the claims that follow, reference will be made to a number of terms that shall be defined to have the following meanings:

The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. As used herein, the singular forms “a,” “an,” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise.

All numerical designations, e.g., pH, temperature, time, concentration, amounts, and molecular weight, including ranges, are approximations which are varied (+) or (−) by 10%, 1%, or 0.1%, as appropriate. It is to be understood, although not always explicitly stated, that all numerical designations may be preceded by the term “about.” It is also to be understood, although not always explicitly stated, that the reagents described herein are merely exemplary and that equivalents of such are known in the art.

“Optional” or “optionally” means that the subsequently described event or circumstance can or cannot occur, and that the description includes instances where the event or circumstance occurs and instances where it does not.

The term “comprising” or “comprises” is intended to mean that the compositions and methods include the recited elements, but not excluding others. “Consisting essentially of” when used to define compositions and methods, shall mean excluding other elements of any essential significance to the combination. For example, a composition consisting essentially of the elements as defined herein would not exclude other elements that do not materially affect the basic and novel characteristic(s) of the claimed invention. “Consisting of” shall mean excluding more than trace amount of other ingredients and substantial method steps recited. Embodiments defined by each of these transition terms are within the scope of this invention.

The terms “patient,” “subject,” “individual,” and the like are used interchangeably herein, and refer to any animal, or cells thereof whether in vitro or in situ, amenable to the methods described herein. In one embodiment, the patient, subject, or individual is a mammal. In some embodiments, the mammal is a mouse, a rat, a guinea pig, a non-human primate, a dog, a cat, or a domesticated animal (e.g., horse, cow, pig, goat, sheep). In some embodiments, the patient, subject or individual is a human.

The term “treating” or “treatment” covers the treatment of a disease or disorder described herein, in a subject, such as a human, and includes: (i) inhibiting a disease or disorder, i.e., arresting its development; (ii) relieving a disease or disorder, i.e., causing regression of the disease or disorder; (iii) slowing progression of the disease or disorder; and/or (iv) inhibiting, relieving, or slowing progression of one or more symptoms of the disease or disorder. For example, treatment of a cancer or tumor includes, but is not limited to, reduction in size of the tumor, elimination of the tumor and/or metastases thereof, remission of the cancer, inhibition of metastasis of the tumor, reduction or elimination of at least one symptom of the cancer, and the like.

The term “administering” or “administration” of an agent to a subject includes any route of introducing or delivering to a subject a compound to perform its intended function. Administration can be carried out by any suitable route, including orally, intranasally, parenterally (intravenously, intramuscularly, intraperitoneally, or subcutaneously), or topically. Administration includes self-administration and the administration by another.

“Pharmaceutically acceptable composition” refers to a composition that is suitable for administration to a mammal, particularly, a human.

It is also to be appreciated that the various modes of treatment or prevention of medical diseases and conditions as described are intended to mean “substantial,” which includes total but also less than total treatment or prevention, and wherein some biologically or medically relevant result is achieved.

The phrase “concurrently administering” refers to administration of at least two agents to a patient over a period of time. As used herein, the word “concurrently” means sufficiently close in time to produce a combined effect (that is, concurrently can be simultaneously, or it can be two or more events occurring within a short time period before or after each other). Concurrent administration includes, without limitation, separate, sequential, and simultaneous administration.

The term “separate” administration refers to an administration of at least two active ingredients at the same time or substantially the same time by different routes or in different compositions.

The term “sequential” administration refers to administration of at least two active ingredients at different times, the administration route being identical or different. More particularly, sequential use refers to the whole administration of one of the active ingredients before administration of the other or others commences. It is thus possible to administer one of the active ingredients over several minutes, hours, or days before administering the other active ingredient or ingredients.

The term “simultaneous” administration refers to the administration of at least two active ingredients by the same route and at the same time or at substantially the same time.

The term “therapeutic” as used herein means a treatment. A therapeutic effect is obtained by suppression, remission, or eradication of a disease state.

The term “prevent” or “preventative” as used herein means a prophylactic treatment. A preventative effect is obtained by delaying the onset of a disease state or decreasing the severity of a disease state when it occurs.

The term “therapeutically effective amount,” “prophylactically effective amount,” or “effective amount” refers to an amount of the agent that, when administered, is sufficient to cause the desired effect. For example, an effective amount of an anti-chemorepellant agent may be an amount sufficient to have an anti-chemorepellant effect on a cancer cell or tumor (e.g., to attenuate a chemorepellant effect from the tumor or cancer cell). The therapeutically effective amount of the agent may vary depending on the tumor being treated and its severity as well as the age, weight, etc., of the patient to be treated. The skilled artisan will be able to determine appropriate dosages depending on these and other factors. The compositions can also be administered in combination with one or more additional therapeutic compounds. In the methods described herein, the therapeutic compounds may be administered to a subject having one or more signs or symptoms of a disease or disorder.

The term “kill” with respect to a cell/cell population is directed to include any type of manipulation that will lead to the death of that cell/cell population.

“Antibodies” as used herein include polyclonal, monoclonal, single chain, chimeric, humanized and human antibodies, prepared according to conventional methodology.

“CXCR4/CXCL12 antagonist” or “CXCR7/CXCL12 antagonist” refers to a compound that antagonizes CXCL12 binding to CXCR4 and/or CXCR7 or otherwise reduces the chemorepellant effect of CXCL12.

By “chemorepellant activity” or “chemorepellant effect” it is meant the ability of an agent to repel (or chemorepel) a eukaryotic cell with migratory capacity (i.e., a cell that can move away from a repellant stimulus), as well as the chemorepellant effect of a chemokine secreted by a cell, e.g., a tumor cell. Usually, the chemorepellant effect is present in an area around the cell wherein the concentration of the chemokine is sufficient to provide the chemorepellant effect. Some chemokines, including interleukin 8 and CXCL12, may exert chemorepellant activity at high concentrations (e.g., over about 100 nM), whereas lower concentrations exhibit no chemorepellant effect and may even be chemoattractant.

Accordingly, an agent with chemorepellant activity is a “chemorepellant agent.” Such activity can be detected using any of a variety of systems well known in the art (see. e.g., U.S. Pat. No. 5,514,555 and U.S. Patent Application Pub. No. 2008/0300165, each of which is incorporated by reference herein in its entirety). A preferred system for use herein is described in U.S. Pat. No. 6,448,054, which is incorporated herein by reference in its entirety.

The term “anti-chemorepellant effect” refers to the effect of the anti-chemorepellant agent to attenuate or eliminate the chemorepellant effect of the chemokine.

“Immune cells” as used herein are cells of hematopoietic origin that are involved in the specific recognition of antigens. Immune cells include antigen presenting cells (APCs), such as dendritic cells or macrophages, B cells, T cells, etc.

The term “anti-cancer therapy” as used herein refers to traditional cancer treatments, including chemotherapy and radiotherapy, as well as vaccine therapy.

The term “engineered antibody” refers to a recombinant molecule that comprises at least an antibody fragment comprising an antigen binding site derived from the variable domain of the heavy chain and/or light chain of an antibody and may optionally comprise the entire or part of the variable and/or constant domains of an antibody from any of the Ig classes (for example IgA, IgD, IgE, IgG, IgM and IgY).

The term “epitope” refers to the region of an antigen to which an antibody binds preferentially and specifically. A monoclonal antibody binds preferentially to a single specific epitope of a molecule that can be molecularly defined. In the present invention, multiple epitopes can be recognized by a multispecific antibody.

A “fusion protein” or “fusion polypeptide” refers to a hybrid polypeptide which comprises polypeptide portions from at least two different polypeptides. The portions may be from proteins of the same organism, in which case the fusion protein is said to be “intraspecies,” “intragenic,” etc. In various embodiments, the fusion polypeptide may comprise one or more amino acid sequences linked to a first polypeptide. In the case where more than one amino acid sequence is fused to a first polypeptide, the fusion sequences may be multiple copies of the same sequence, or alternatively, may be different amino acid sequences. A first polypeptide may be fused to the N-terminus, the C-terminus, or the N- and C-terminus of a second polypeptide. Furthermore, a first polypeptide may be inserted within the sequence of a second polypeptide.

The term “immunogenic” refers to the ability of a substance to elicit an immune response. An “immunogenic composition” or “immunogenic substance” is a composition or substance which elicits an immune response. An “immune response” refers to the reaction of a subject to the presence of an antigen, which may include at least one of the following: making antibodies, developing immunity, developing hypersensitivity to the antigen, and developing tolerance.

The term “linker” is art-recognized and refers to a molecule or group of molecules connecting two compounds, such as two polypeptides. The linker may be comprised of a single linking molecule or may comprise a linking molecule and a spacer molecule, intended to separate the linking molecule and a compound by a specific distance.

As used herein, a “stress protein,” also known as a “heat shock protein” or “Hsp,” is a protein that is encoded by a stress gene, and is therefore typically produced in significantly greater amounts upon the contact or exposure of the stressor to the organism. The term “stress protein” as used herein is intended to include such portions and peptides of a stress protein. A “stress gene,” also known as “heat shock gene,” as used herein, refers to a gene that is activated or otherwise detectably upregulated due to the contact or exposure of an organism (containing the gene) to a stressor, such as but not limited to heat shock, hypoxia, glucose deprivation, heavy metal salts, inhibitors of energy metabolism and electron transport, and protein denaturants, or to certain benzoquinone ansamycins. Nover, L., IHeat Shock Response, CRC Press, Inc., Boca Raton, Fla. (1991). “Stress gene” also includes homologous genes within known stress gene families, such as certain genes within the IHsp70 and Hsp90 stress gene families, even though such homologous genes are not themselves induced by a stressor. Each of the terms stress gene and stress protein as used in the present specification may be inclusive of the other, unless the context indicates otherwise.

The term “vaccine” refers to a substance that elicits an immune response and also confers protective immunity upon a subject.

Anti-Chemorepellant Agents

Many tumors have chemorepellant effects, e.g., on immune cells, due to chemokines secreted by the tumor cells. High concentrations of the chemokines secreted by the tumor cells can have chemorepellant effects on cells, whereas lower concentrations do not have such effects or even result in chemoattraction. For example, T-cells are repelled by CXCL12 (SDF-1) by a concentration-dependent and CXCR4 receptor-mediated mechanism.

The anti-chemorepellant agent may be any such agent known in the art, for example an anti-chemorepellant agent as described in U.S. Patent Application Publication No. 2008/0300165, which is hereby incorporated by reference in its entirety.

Anti-chemorepellant agents include any agents that specifically inhibit chemokine and/or chemokine receptor dimerization, thereby blocking the chemorepellant response to a chemorepellant agent. Certain chemokines, including IL-8 and CXCL12, can also serve as chemorepellants at high concentrations (e.g., above 100 nM) where much of the chemokine exists as a dimer. Dimerization of the chemokine elicits a differential response in cells, causing dimerization of chemokine receptors, an activity which is interpreted as a chemorepellant signal. Blocking the chemorepellant effect of high concentrations of a chemokine secreted by a tumor can be accomplished, for example, by anti-chemorepellant agents which inhibit chemokine dimer formation or chemokine receptor dimer formation. For example, antibodies that target and block chemokine receptor dimerization, e.g., by interfering with the dimerization domains or ligand binding, can be anti-chemorepellant agents. Anti-chemorepellant agents that act via other mechanisms of action, e.g., that reduce the amount of chemorepellant cytokine secreted by the cells, inhibit dimerization, and/or inhibit binding of the chemokine to a target receptor, are also encompassed by the present invention. Where desired, this effect can be achieved without inhibiting the chemotactic action of monomeric chemokine.

In other embodiments, the anti-chemorepellant agent is a CXCR4 antagonist, CXCR7 antagonist, CXCR3 antagonist, CXCR4/CXCL12 antagonist, CXCR7/CXCL12 antagonist, or selective PKC inhibitor. Anti-chemorepellant agents may include, without limitation, molecules that inhibit expression of CXCL12 or CXCR4 or CXCR7 (e.g., antisense or siRNA molecules), molecules that bind to CXCL12 or CXCR4 or CXCR7 and inhibit their function (e.g., antibodies or aptamers), molecules that inhibit dimerization of CXCL12 or CXCR4 or CXCR7, and antagonists of CXCR4 or CXCR7.

The CXCR4 antagonist can be but is not limited to AMD3100 (plerixafor) or a derivative thereof, AMD11070 (also called AMD070), AMD12118, AMD11814, AMD13073, FAMD3465, C131, BKT140, CTCE-9908, KRH-2731, TC14012, KRH-3955, BMS-936564/MDX-1338, LY2510924, GSK812397, KRH-1636, T-20, T-22, T-140, TE-14011, T-14012, or TN14003, derivatives thereof, or an antibody that interferes with the dimerization of CXCR4. Additional CXCR4 antagonists are described, for example, in U.S. Patent Pub. No. 2014/0219952 and Debnath et al. Theranostics, 2013; 3(1): 47-75, each of which is incorporated herein by reference in its entirety, and include ‘T’G-0054 (burixafor), AMD3465, NIBR1816, AMD070, and derivatives thereof.

The CXCR3 antagonist can be but is not limited to TAK-779, AK602, or SCH-351125, or an antibody that interferes with the dimerization of CXCR3.

The CXCR4/CXCL12 antagonist can be but is not limited to tannic acid, NSC 651016, or an antibody that interferes with the dimerization of CXCR4 and/or CXCL12.

The CXCR7/CXCL12 antagonist can be but is not limited to CCX771, CCX754, or an antibody that interferes with the dimerization of CXCR7 and/or CXCL12.

The selective PKC inhibitor can be but is not limited to thalidomide or GF 109230X.

In one embodiment, the anti-fugetactic agent is AMD3100 (plerixafor). AMD3100 is described in U.S. Pat. No. 5,583,131, which is incorporated by reference herein in its entirety.

In one embodiment, the anti-chemorepellant agent is an AMD3100 derivative. AMD3100 derivatives include, but are not limited to, those found in U.S. Pat. Nos. 7,935,692 and 5,583,131 (USRE42152), each of which is incorporated herein by reference in its entirety.

In certain embodiments, the anti-chemorepellant agent is not an antibody. In certain embodiments, the anti-chemorepellant agent is not a heparinoid. In certain embodiments, the anti-chemorepellant agent is not a peptide.

In one embodiment, the anti-chemorepellant agent is coupled with a molecule that allows targeting of a tumor. In one embodiment, the anti-chemorepellant agent is coupled with (e.g., bound to) an antibody specific for the tumor to be targeted. In one embodiment, the anti-chemorepellant agent coupled to the molecule that allows targeting of the tumor is administered systemically.

In one embodiment, the anti-chemorepellant agent is administered in combination with an additional compound that enhances the anti-chemorepellant activity of the agent. In one embodiment, the additional compound is granulocyte colony stimulating factor (G-CSF). In one embodiment, G-CSF is not administered.

Fusion Protein

This disclosure relates to fusion proteins comprising a stress protein component and a cancer cell binding component, and methods of using the same. In particular, this disclosure relates to treating a patient having a disease, e.g. a cancer cell or tumor, that can be recognized by a fusion protein as described herein. Preferably, the disease expresses a chemorepellant activity such that immune cells are inhibited in the vicinity of the cancer cells.

Examples and methods of making fusion proteins contemplated in the present invention are described in U.S. Pat. Nos. 8,143,387 and 7,943,133 and PCT Application Number PCT/US2017/021911, each of which is incorporated herein by reference in its entirety.

Stress Protein Component

The stress protein component (also referred to as the stress protein domain) may comprise any polypeptide sequence that activates APCs. In some embodiments, the polypeptide sequence is derived from a stress protein. However, any APC-activating polypeptide is contemplated.

Any suitable stress protein (e.g., heat shock protein (Hsp)) can be used in the fusion polypeptides of the present invention. For example, Hsp60 and/or Hsp70 can be used. Turning to stress proteins generally, cells respond to a stressor (typically heat shock treatment) by increasing the expression of a group of genes commonly referred to as stress, or heat shock, genes. Heat shock treatment involves exposure of cells or organisms to temperatures that are one to several degrees Celsius above the temperature to which the cells are adapted. In coordination with the induction of such genes, the levels of corresponding stress proteins increase in stressed cells.

In bacteria, the predominant stress proteins are proteins with molecular sizes of about 70 and 60 kDa, which are commonly referred to as 1-Hsp70 and Hsp60, respectively. Stress proteins appear to participate in important cellular processes such as protein synthesis, intracellular trafficking, and assembly and disassembly of protein complexes. It appears that the increased amounts of stress proteins synthesized during stress serve primarily to minimize the consequences of induced protein unfolding. Indeed, the pre-exposure of cells to mildly stressful conditions that induce the synthesis of stress proteins affords protection to the cells from the deleterious effects of a subsequent, more extreme stress.

The major stress proteins appear to be expressed in every organism and tissue type examined so far. Also, it appears that stress proteins represent the most highly conserved group of proteins identified to date. For example, when stress proteins in widely diverse organisms are compared, Hsp90 and Hsp70 exhibit 50% or higher identity at the amino acid level and share many similarities at non-identical positions. Similar or higher levels of homology exist between different members of a particular stress protein family within species.

The stress proteins, particularly Hsp70, Hsp60, Hsp20-30 and Hsp 10, are among the major determinants recognized by the host immune system in the immune response to infection by Mycobacterium tuberculosis and Mycobacterium leprae. However, individuals, including healthy individuals with no history of mycobacterial infection or autoimmune disease, also carry T cells that recognize both bacterial and human Hsp60 epitopes. This system recognizing stress protein epitopes presumably constitutes an “early defense system” against invading organisms. The system may be maintained by frequent stimulation by bacteria and viruses.

Families of stress genes and proteins for use in the fusion polypeptides are those well known in the art and include, for example, lisp 100-200, Hsp100, Hsp90. Lon. Hsp70, Hsp60, TF55, Hsp40, FKBPs, cyclophilins, Hsp20-30, ClpP, GrpE, Hsp10, ubiquitin, calnexin, and protein disulfide isomerases. In certain embodiments, the stress protein is Hsp70 or Hsp60. In certain embodiments, the stress protein is a fragment of Hsp70 or Hsp60 and/or a modified sequence of Hsp70 or Hsp60. As use herein, a “modified sequence” of a stress protein such as Hsp70 is a sequence comprising one or more additions, deletion, or substitutions that retains at least 50% of at least one of the biological activity of the stress protein, e.g., the ability to stimulate antigen presenting cells, e.g., at least 50%, 60%, 70%, 80%, or more of the biological activity. In some embodiments, the modified sequence has an enhanced biological activity compared to the wild-type sequence. In some embodiments, the modified sequence is one disclosed in PCT Application No. PCT/S2017/021911, incorporated by reference herein in its entirety.

Hsp100-200 examples include Grp170 (for glucose-regulated protein). Hsp100 examples include mammalian Hsp110, yeast Hsp104, ClpA, ClpB, ClpC, ClpX and ClpY. Hsp90 examples include HtpG in E. coli, Hsp83 and Hsc83 in yeast, and Hsp90alpha, Hsp90beta and Grp94 in humans. Hsp70 examples include Hsp72 and Hsc73 from mammalian cells, DnaK from bacteria, particularly mycobacteria such as Mycobacterium leprae, Mycobacterium tuberculosis, and Mycobacterium bovis (such as Bacille-Calmette Guerin, referred to herein as Hsp71), DnaK from Escherichia coli, yeast, and other prokaryotes, and BiP and Grp78. Hsp60 examples include Hsp65 from mycobacteria. Bacterial Hsp60 is also commonly known as GroEL, such as the GroEL from E. coli. TF55 examples include Tep1, TRiC and thermosome. Hsp40 examples include DnaJ from prokaryotes such as E. coli and mycobacteria and HSJ1, HDJ1 and Hsp40. FKBPs examples include FKBP12, FKBP13, FKBP25, and FKBP59, Fpr1 and Nep1. Cyclophilin examples include cyclophilins A, Band C. Hsp10 examples include GroES and Cpn10.

In particular embodiments, the stress proteins of the present invention are obtained from enterobacteria, mycobacteria (particularly M. leprae, M. tuberculosis, M. vaccae, M. smegmatis and M. bovis), E. coli, yeast, Drosophila, vertebrates, avians, chickens, mammals, rats, mice, primates, or humans.

In one embodiment, the stress protein comprises Mycobacterium tuberculosis-derived heat shock protein 70 (MtbHsp70). MtbHsp70 is well characterized and functions as a potent immune-activating adjuvant. It stimulates monocytes and dendritic cells (DCs) to produce CC-chemokines, which attract antigen processing and presenting macrophages, DCs, and effector T and B cells.

A fusion polypeptide may comprise an amino acid sequence that is at least about 80%, 85%, 90%, 95%, 98%, or 99% identical to a stress protein described herein.

A fusion polypeptide may comprise an amino acid sequence which is a fragment and/or modification of the stress protein as described herein.

Target Binding Component

The target binding component of the fusion protein may be any molecule that specifically binds an antigen associated with the disease to be treated. In certain embodiments, the target binding component is an antibody or a fragment thereof. The terms “antigen-binding,” “target binding,” and “tumor-binding” are used interchangeably herein.

In one aspect, the target binding component is a single chain antibody. In one aspect, the target binding component is a variable domain fragment. In one aspect, the target binding component is a Fab portion of an antibody.

In one aspect, the target binding component is specific for a cancer antigen (e.g., a tumor-specific antigen or a tumor-associated antigen), and may be referred to as a cancer cell or tumor binding component. The cancer antigen may be any identifiable cell surface antigen that is expressed by a cancer cell of interest. In one embodiment, the cancer antigen is mesothelin, alphafetoprotein, CEA, CA-125, MUC-1, Her2Neu, ETA, NY-ESO-1, VEGF, VEGFR1, VEGFR2, PSMA, prostate specific antigen, HPV17E7, mutant p53, surviving, ras, MAGE, gp100, tyrosinase, WT1, PR1, folate-binding protein, CA-19-9, FAP, G250, or A33. In one embodiment, the antibody is specific for mesothelin. Fusion proteins that recognize and bind to mesothelin are described, for example, in U.S. Pat. No. 7,943,133, which is incorporated herein by reference in its entirety.

Fusion Proteins Targeting Mesothelin

In one embodiment, the target binding component is specific for mesothelin. MSLN is highly overexpressed on the surface of common epithelial cancers, including epithelial malignant mesothelioma and ovarian cancer, while expressed at relatively low levels only in mesothelial cells lining the pleura, pericardium, and peritoneum in healthy individuals.

In theory, fusion of anti-MSLN scFv and MtbHsp70 takes advantage of the immune-activating action of MtbHsp70 and the tumor-targeting activity of the scFv, which will yield anti-tumor responses against the broadest profile of tumor antigens.

In one embodiment, the fusion protein comprises a peptide having at least about 85% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having at least about 90% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having at least about 91% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having at least about 92% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having at least about 93% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having at least about 94% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having at least about 95% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having at least about 96% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.; 2. In one embodiment, the fusion protein comprises a peptide having at least about 97% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having at least about 98% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having at least about 99% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.: 2. In one embodiment, the fusion protein comprises a peptide having a sequence disclosed in PCT Application No. PCT/US2017/021911, incorporated by reference herein in its entirety, or a sequence having at least 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence homology to a sequence disclosed therein.

In one embodiment, the fusion protein retains the ability to bind a cancer antigen. In one embodiment, the fusion protein retains the ability to activate APCs. In one embodiment, the fusion protein retains the ability to facilitate production of activated APCs having cancer-specific antigens on the APC cell surface.

In one embodiment, the fusion protein comprises the peptide sequence of SEQ ID NO.: 1. In one embodiment, the fusion protein comprises the peptide sequence of SEQ ID NO.: 2.

Methods of Treatment

The fusion protein as described herein can be used in combination with an anti-chemorepellant agent to treat a cancer cell or tumor which is associated with a chemorepellant effect.

In one aspect, this invention relates to a method for treating a cancer, e.g., a tumor, in a patient wherein the cancer or tumor expresses chemorepellant properties, the method comprising administering to the patient: a) an effective amount of a fusion protein; and b) concurrently administering to the patient an effective amount of an anti-chemorepellant agent; wherein the combination of the fusion protein and the anti-chemorepellant agent treat the cancer or tumor. In one embodiment, the fusion protein comprises a cancer cell binding component and a stress protein component, wherein the cancer cell binding component binds to the cancer and the stress protein component activates dendritic cells, leading to the generation of CD3 positive T-cells that target cancer antigens.

In one embodiment, the anti-chemorepellant agent and the fusion protein are administered separately, e.g., by the same or different routes. In one embodiment, the anti-chemorepellant agent and the fusion protein are administered simultaneously, in the same or different compositions, e.g., by the same or different routes. In one embodiment, the anti-chemorepellant agent and the fusion protein are administered sequentially, e.g., by the same or different routes.

In one embodiment, the anti-chemorepellant agent is administered prior to administration of the fusion protein. In one embodiment, the anti-chemorepellant agent is administered after administration of the fusion protein. In one embodiment, the anti-chemorepellant agent is administered before, during and/or after administration of the fusion protein.

In some embodiments, the anti-chemorepellant agent is administered between one minute and 24 hours prior to administration of the fusion protein. In some embodiments, the anti-chemorepellant agent is administered 1, 2, 3, 4, 5, 6, or 7 days prior to administration of the fusion protein.

In some embodiments, the anti-chemorepellant agent is administered for a period of time sufficient to reduce or attenuate the chemorepellant effect of the tumor, e.g., such that the anti-chemorepellant agent has an anti-chemorepellant effect; the fusion protein can then be administered for a period of time during which the chemorepellant effect of the tumor is reduced or attenuated.

In some embodiments, the anti-chemorepellant agent is administered between one minute and 24 hours after administration of the fusion protein. In some embodiments, the anti-chemorepellant agent is administered 1, 2, 3, 4, 5, 6, or 7 days after administration of the fusion protein.

In one embodiment, the anti-chemorepellant agent and/or fusion protein is administered intravenously, subcutaneously, orally, or intraperitoneally. In one embodiment, the anti-chemorepellant agent is administered proximal to (e.g., near or within the same body cavity as) the tumor. In one embodiment, the anti-chemorepellant agent is administered directly into the tumor or into a blood vessel feeding the tumor. In one embodiment, the anti-chemorepellant agent is administered systemically. In a further embodiment, the anti-chemorepellant agent is administered by microcatheter, an implanted device, or an implanted dosage form.

In one embodiment, the anti-chemorepellant agent is administered in a continuous manner for a defined period. In another embodiment, anti-chemorepellant agent is administered in a pulsatile manner. For example, the anti-chemorepellant agent may be administered intermittently over a period of time.

Cancers or tumors that can be treated by the compounds and methods described herein include, but are not limited to: anal cancer; biliary tract cancer; brain cancer, including glioblastomas and medulloblastomas; breast cancer; cervical cancer; choriocarcinoma; colon cancer; endometrial cancer; esophageal cancer, gastric cancer; head and neck cancer; hematological neoplasms, including acute lymphocytic and myelogenous leukemia; multiple myeloma; AIDS associated leukemias and adult T-cell leukemia lymphoma; intraepithelial neoplasms, including Bowen's disease and Paget's disease; liver cancer (hepatocarcinoma); lung cancer; lymphomas, including Hodgkin's disease and lymphocytic lymphomas; mesothelioma; neuroblastomas; oral cancer, including squamous cell carcinoma; ovarian cancer, including those arising from epithelial cells, stromal cells, germ cells and mesenchymal cells; pancreas cancer; prostate cancer; rectal cancer; sarcomas, including leiomyosarcoma, rhabdomyosarcoma, liposarcoma, fibrosarcoma and osteosarcoma; skin cancer, including melanoma, Kaposi's sarcoma, basocellular cancer and squamous cell cancer; testicular cancer, including germinal tumors (seminoma, non-seminoma [teratomas, choriocarcinomas]), stromal tumors and germ cell tumors; thyroid cancer, including thyroid adenocarcinoma and medullar carcinoma: and renal cancer including adenocarcinoma and Wilms tumor. In important embodiments, cancers or tumors escaping immune recognition include glioma, colon carcinoma, colorectal cancer, anal cancer, head and neck cancer, ovarian cancer, lymphoid cell-derived leukemia, choriocarcinoma, and melanoma. In one embodiment, the tumor cells derive from mesothelioma. In one embodiment, the tumor cells are from a hematological malignancy. In one embodiment, the cancer is HPV-positive.

In one embodiment, the cancer is a solid tumor. In one embodiment, the cancer is a leukemia, lymphoma, or myeloma. In one embodiment, the cancer over-expresses CXCL12, e.g., expresses an amount of CXCL12 in the tumor microenvironment sufficient to have a chemorepellant effect. In one embodiment, cancer expression of CXCL12 can be evaluated prior to administration of a composition as described herein. For example, a patient having a cancer that is determined to express or over-express CXCL12, e.g., a concentration of about 100 nM or higher, e.g., about 100, 150, 200, 250, 300, 350, 400, 450, or 500 nM, will be treated using a method and/or composition as described herein.

Dose and Administration

The compositions, as described herein, are administered in effective amounts. The effective amount will depend upon the mode of administration, the particular condition being treated and the desired outcome. It will also depend upon, as discussed above, the stage of the condition, the age and physical condition of the subject, the nature of concurrent therapy, if any, and like factors well known to the medical practitioner. For therapeutic applications, it is that amount sufficient to achieve a medically desirable result.

Generally, the dose of the anti-chemorepellant agent of the present invention is from about 0.001 to about 100 mg/kg body weight per day, e.g., about 5 mg/kg body weight per day to about 50 mg/kg per day, e.g., about 5, 10, 15, 20, 25, 30, 35, 40, 45, or 50 mg/kg per day inclusive of all values and ranges therebetween, including endpoints. In one embodiment, the dose is from about 10 mg/kg to about 50 mg/kg per day. In one embodiment, the dose is from about 10 mg/kg to about 40 mg/kg per day. In one embodiment, the dose is from about 10 mg/kg to about 30 mg/kg per day. In one embodiment, the dose is from about 10 mg/kg to about 20 mg/kg per day. In one embodiment, the dose does not exceed about 50 mg per day.

In one embodiment, the dose of the anti-chemorepellant agent is from about 50 mg/kg per week to about 350 mg/kg per week, inclusive of all values and ranges therebetween, including endpoints. In one embodiment, the dose of the anti-chemorepellant agent is about 50 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 60 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 70 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 80 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 90 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 100 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 110 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 120 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 130 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 140 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 150 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 160 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 170 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 180 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 190 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 200 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 210 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 220 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 230 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 240 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 250 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 260 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 270 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 280 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 290 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 300 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 310 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 320 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 330 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 340 mg/kg per week. In one embodiment, the dose of the anti-chemorepellant agent is about 350 mg/kg per week.

In one aspect of the invention, administration of the anti-chemorepellant agent is pulsatile. In one embodiment, an amount of anti-chemorepellant agent is administered every 1 hour to every 24 hours, for example every 1 hour, 2 hours, 3 hours, 4 hours, 5 hours, 6 hours, 7 hours, 8 hours, 9 hours, 10 hours, 11 hours, 12 hours, 13 hours, 14 hours 15 hours, 16 hours, 17 hours, 18 hours, 19 hours, 20 hours, 21 hours, 22 hours, 23 hours, or 24 hours. In one embodiment, an amount of anti-chemorepellant agent is administered every 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, or 10 days.

In one aspect of the invention, doses of the anti-chemorepellant agent are administered in a pulsatile manner for a period of time sufficient to have an anti-chemorepellant effect (e.g., to attenuate the chemorepellant effect of the tumor cell). In one embodiment, the period of time is between about 1 day and about 10 days. For example, the period of time may be 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 7 days, 8 days, 9 days, or 10 days. In some embodiments, the fusion protein is administered after the anti-chemorepellant effect has occurred, e.g., one or more days after the anti-chemorepellant agent has been administered. In some embodiments, administration of the chemorepellant agent is continued while the fusion protein is being administered.

A variety of administration routes are available. The methods of the invention, generally speaking, may be practiced using any mode of administration that is medically acceptable, meaning any mode that produces effective levels of the active compounds without causing clinically unacceptable adverse effects.

Modes of administration include oral, rectal, topical, nasal, intradermal, or parenteral routes. The term “parenteral” includes subcutaneous, intravenous, intramuscular, or infusion. Intravenous or intramuscular routes are not particularly suitable for long-term therapy and prophylaxis. They could, however, be preferred in emergency situations. Oral administration will be preferred for prophylactic treatment because of the convenience to the patient as well as the dosing schedule. When peptides are used therapeutically, in certain embodiments a desirable route of administration is by pulmonary aerosol. Techniques for preparing aerosol delivery systems containing peptides are well known to those of skill in the art. Generally, such systems should utilize components which will not significantly impair the biological properties of the antibodies, such as the paratope binding capacity (see, for example, Sciarra and Cutie, “Aerosols,” in Remington's Pharmaceutical Sciences, 18th edition, 1990, pp 1694-1712; incorporated by reference). Those of skill in the art can readily determine the various parameters and conditions for producing antibody or peptide aerosols without resort to undue experimentation.

Compositions suitable for oral administration may be presented as discrete units, such as capsules, tablets, lozenges, each containing a predetermined amount of the active agent(s). Other compositions include suspensions in aqueous liquids or non-aqueous liquids such as a syrup, elixir or an emulsion.

Preparations for parenteral administration include sterile aqueous or non-aqueous solutions, suspensions, and emulsions. Examples of non-aqueous solvents are propylene glycol, polyethylene glycol, vegetable oils such as olive oil, and injectable organic esters such as ethyl oleate. Aqueous carriers include water, alcoholic/aqueous solutions, emulsions or suspensions, including saline and buffered media. Parenteral vehicles include sodium chloride solution, Ringer's dextrose, dextrose and sodium chloride, lactated Ringer's or fixed 25 oils. Intravenous vehicles include fluid and nutrient replenishers, electrolyte replenishers (such as those based on Ringer's dextrose), and the like. Preservatives and other additives may also be present such as, for example, antimicrobials, anti-oxidants, chelating agents, and inert gases and the like. Lower doses will result from other forms of administration, such as intravenous administration. In the event that a response in a subject is insufficient at the initial doses applied, higher doses (or effectively higher doses by a different, more localized delivery route) may be employed to the extent that patient tolerance permits. Multiple doses per day are contemplated to achieve appropriate systemic levels of compounds.

In one embodiment, the anti-chemorepellant agent is administered parenterally. In one embodiment, the anti-chemorepellant agent is administered via microcatheter into a blood vessel proximal to a tumor. In one embodiment, the anti-chemorepellant agent is administered via microcatheter into a blood vessel within a tumor. In one embodiment, the anti-chemorepellant agent is administered subcutaneously. In one embodiment, the anti-chemorepellant agent is administered intradermally.

Other delivery systems can include time-release, delayed release or sustained release delivery systems. Such systems can avoid repeated administrations of the anti-chemorepellant agent, increasing convenience to the subject and the physician. Many types of release delivery systems are available and known to those of ordinary skill in the art. They include polymer base systems such as poly(lactide-glycolide), copolyoxalates, polycaprolactones, polyesteramides, polyorthoesters, polyhydroxybutyric acid, and polyanhydrides. Microcapsules of the foregoing polymers containing drugs are described in, for example, U.S. Pat. No. 5,075,109. Delivery systems also include non-polymer systems that are: lipids including sterols such as cholesterol, cholesterol esters and fatty acids or neutral fats such as mono- di- and tri-glycerides; hydrogel release systems; sylastic systems; peptide based systems; wax coatings; compressed tablets using conventional binders and excipients; partially fused implants; and the like.

In one embodiment, the anti-chemorepellant agent is administered in a time-release, delayed release or sustained release delivery system. In one embodiment, the time-release, delayed release or sustained release delivery system comprising the anti-chemorepellant agent is inserted directly into the tumor. In one embodiment, the time-release, delayed release or sustained release delivery system comprising the anti-chemorepellant agent is implanted in the patient proximal to the tumor. Additional implantable formulations are described, for example, in U.S. Patent App. Pub. No. 2008/0300165, which is incorporated herein by reference in its entirety.

In addition, important embodiments of the invention include pump-based hardware delivery systems, some of which are adapted for implantation. Such implantable pumps include controlled-release microchips. An exemplary controlled-release microchip is described in Santini, J T Jr. et al., Nature, 1999, 397:335-338, the contents of which are expressly incorporated herein by reference.

When administered, the pharmaceutical preparations of the invention are applied in pharmaceutically-acceptable amounts and in pharmaceutically-acceptably compositions. Such preparations may routinely contain salt, buffering agents, preservatives, compatible carriers, and optionally other therapeutic agents. When used in medicine, the salts should be pharmaceutically acceptable, but non-pharmaceutically acceptable salts may conveniently be used to prepare pharmaceutically-acceptable salts thereof and are not excluded from the scope of the invention. Such pharmacologically and pharmaceutically-acceptable salts include, but are not limited to, those prepared from the following acids: hydrochloric, hydrobromic, sulfuric, nitric, phosphoric, maleic, acetic, salicylic, citric, formic, malonic, succinic, and the like. Also, pharmaceutically-acceptable salts can be prepared as alkaline metal or alkaline earth salts, such as sodium, potassium or calcium salts.

Pharmaceutical Compositions

In one aspect, this invention relates to a pharmaceutical composition comprising a fusion protein as described herein and an anti-chemorepellant agent. In one embodiment, the composition further comprises antigen-presenting cells. In one embodiment, the antigen-presenting cells are dendritic cells. In one embodiment, the antigen-presenting cells are derived from the patient to be treated. In one embodiment, the antigen-presenting cells express CXCR4 and/or CXCR7 on the cell surface.

In one embodiment, the composition comprises an effective amount of the fusion protein to activate the antigen-presenting cells. In one embodiment, the composition comprises an effective amount of the anti-chemorepellant agent to reduce the chemorepellant effect of the cancer. In one embodiment, the composition comprises an effective amount of the antigen presenting cells to result in activation of T cells against the cancer.

In one embodiment, the pharmaceutical composition is formulated for injection.

In one embodiment, the composition comprises a pharmaceutically acceptable excipient. Acceptable excipients are non-toxic, aid administration, and do not adversely affect the therapeutic benefit of the claimed compounds. Such excipient may be any solid, liquid, semi-solid or gaseous excipient that is generally available to one of skill in the art.

Solid pharmaceutical excipients include starch, cellulose, talc, glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silica gel, magnesium stearate, sodium stearate, glycerol monostearate, sodium chloride, dried skim milk and the like. Liquid and semisolid excipients may be selected from glycerol, propylene glycol, water, ethanol and various oils, including those of petroleum, animal, vegetable or synthetic origin, e.g., peanut oil, soybean oil, mineral oil, sesame oil, etc. Preferred liquid carriers, particularly for injectable solutions, include water, saline, aqueous dextrose, and glycols. Other suitable pharmaceutical excipients and their formulations are described in Remington's Pharmaceutical Sciences, edited by E. W. Martin (Mack Publishing Company, 22nd ed., 2013).

In order to ensure that the dendritic cells and fusion protein interact once administered to a patient, the cells and protein may be combined prior to administration. In one embodiment, the cells and protein are combined immediately (e.g., seconds to one or two hours) prior to administration to the patient.

Without being bound by theory, it is believed that combination of the antigen-presenting cells and the anti-chemorepellant agent prior to administration to the patient will allow binding of the anti-chemorepellant agent to cell surface receptors (e.g., CXCR4 or CXCR7), thereby allowing the cells to overcome the chemorepellant effect of the tumor. In contrast, it is contemplated that the systemic delivery of an anti-chemorepellant agent results in indiscriminate binding of that agent to CXCR4 and/or CXCR7 receptors throughout the body.

Kit of Parts

In one aspect, this invention relates to a kit of parts for treatment of a disease, the kit comprising a fusion protein and an anti-chemorepellant agent.

In one embodiment is provided a kit of parts for treatment of a cancer, e.g., a tumor, in a patient, the kit comprising a therapeutically effective amount of an anti-chemorepellant agent and a fusion protein comprising a cancer cell binding component and a stress protein component, wherein the cancer cell binding component recognizes an antigen expressed by the cancer.

In one embodiment, the anti-chemorepellant agent is any of the agents disclosed previously, e.g., selected from the group consisting of AMD3100 or a derivative thereof, AMD11070 (also called AMD070), AMD12118, AMD11814, AMD13073, FAMD3465, C131, BKT140, CTCE-9908, KRH-2731, TC14012, KRH-3955, BMS-936564/MDX-1338, LY2510924, GSK812397, KRH-1636, T-20, T-22, T-140, TE-14011, T-14012, TN14003, TAK-779, AK602, SCH-351125, tannic acid, NSC 651016, thalidomide, GF 109230X, an antibody that interferes with dimerization of a chemorepellant chemokine, and an antibody that interferes with dimerization of a receptor for a chemorepellant chemokine. In one embodiment, the anti-chemorepellant agent is AMD3100 or a derivative thereof. In one embodiment, the anti-chemorepellant agent is AMD3100.

In one embodiment, the stress protein is HSP70 or an immune activating fragment and/or modified sequence thereof. In one embodiment, the HSP70 or the immune activating fragment or modified sequence thereof is from Mycobacterium tuberculosis.

In one embodiment, the tumor binding component is a single chain antibody, a variable domain, or a Fab domain.

In one embodiment, the fusion protein and/or the anti-chemorepellant agent are formulated for injection.

In one embodiment, the fusion protein and the anti-chemorepellant agent are in the same formulation.

In one embodiment, the kit further comprises instructions for treating the cancer or tumor. In one embodiment, the kit of parts comprises instructions in a readable medium for dosing and/or administration of the anti-chemorepellant agent and the fusion protein.

The term “readable medium” as used herein refers to a representation of data that can be read, for example, by a human or by a machine. Non-limiting examples of human-readable formats include pamphlets, inserts, or other written forms. Non-limiting examples of machine-readable formats include any mechanism that provides (i.e., stores and/or transmits) information in a form readable by a machine (e.g., a computer, tablet, and/or smartphone). For example, a machine-readable medium includes read-only memory (ROM); random access memory (RAM); magnetic disk storage media; optical storage media; and flash memory devices. In one embodiment, the machine-readable medium is a CD-ROM. In one embodiment, the machine-readable medium is a USB drive. In one embodiment, the machine-readable medium is a Quick Response Code (QR Code) or other matrix barcode.

EXAMPLES Example 1. Construction of VIC-008 Fusion Protein

The fusion protein scFv-MtbHsp70 was constructed with VH and VL from anti-MSLN p4 scFv (Bergan L, et al. Development and in vitro validation of anti-mesothelin biobodies that prevent CA125/Mesothelin-dependent cell attachment. Cancer Letters. 2007; 255(2):263-74) fused to full length MtbHsp70 with a (G₄S)₃ linker in between, which has been shown in our previous study (Yuan J, et al. A novel mycobacterial Hsp70-containing fusion protein targeting mesothelin augments antitumor immunity and prolongs survival in murine models of ovarian cancer and mesothelioma. Journal of Hematology & Oncology. 2014; 7:15). The original fusion protein VIC-007, on which VIC-008 was based, achieved significant control of tumor growth and prolongation of the survival of tumor-bearing mice, but the antitumoral efficacy of the treatment regimen was not optimal. Antigenic peptides bind to MtbHsp70 through non-covalent interactions and can elicit both MHC class 1-restricted CD8+ and MIC class II-restricted CD4+r-cell responses. A new version of the scFv-MtbHsp70 fusion protein, VIC-008, was developed, which was modified from the original VIC-007 by the elimination of redundant amino acids and the introduction of a single amino acid mutation, phenylalanine (F) in place of valine (V), at position 381 of MtbHsp70 (FIG. 1). This change is designed to prevent peptide binding while retaining the immune-stimulatory capacity of the protein, in order to reduce the possibility that MtbHsp70 might incidentally bind and deliver other antigens that could result in off target effects or the induction of tolerance or autoimmunity.

The fusion proteins were constructed and expressed by WuXi App Tech (Shanghai, China) in CHO cells and provided at a purity of above 95% by HPLC and an endotoxin level of less than 1.0 EU/mg. VIC-008 is further described in Zeng Y., el al. (Improved Antitumoral Efficacy of Mesothelin Targeted Immune Activating Fusion Protein in Murine Model of Ovarian Cancer. Int J Cancer Clin Res 2016; 3:05) and U.S. Provisional Application No. 62/306,168, each of which is incorporated herein by reference in its entirety.

Example 2. VIC-008 Enhances Control of Tumor Growth

Ovarian cancer was established by intraperitoneal (i.p.) injection of syngeneic cancer cells, Luc-ID8 (5×10⁶ cells per mouse), into 6-week-old female C57BL/6 mice. All mice were purchased from Jackson laboratories. Mice were observed daily for 1 week after inoculation of tumor cells. Tumor generations were consistently first evident via abdominal distension secondary to malignant ascites, and tumor-bearing mice were euthanized at the endpoint when there were signs of distress, including fur ruffling, rapid respiratory rate, hunched posture, reduced activity, and progressive ascites formation.

Mice with ovarian tumors were treated 7 days after tumor cell inoculation with i.p. injections of VIC-007 (4 μg per mouse), VIC-008 (4 μg per mouse), or normal saline. This was followed by 3 further treatments at 7-day intervals.

Intraperitoneal tumor growth was monitored weekly after tumor cell inoculation using in vivo live imaging by IVIS Spectrum (PerkinElmer). Mice were injected intraperitoneally with 150 mg/kg body weight of D-luciferin 10 min in advance and subsequently imaged by IVIS Spectrum.

As shown in FIGS. 2A-2B, both VIC-007 and VIC-008 significantly slowed tumor growth as recorded by bioluminescence signals compared to saline (p<0.0001 and p<0.0001) while VIC-008 further significantly delayed tumor growth compared to VIC-007 (p<0.0001). Statistical differences between three or more experimental groups were analyzed using Two-Way ANOVA, followed by Tukey's multiple comparison tests when mean of each group is compared with that of every other group.

Example 3. VIC-008 Enhances the Prolongation of Mouse Survival

The efficacy of VIC-007 and VIC-008 to prolong survival in the tumor-bearing mice was evaluated in the mice treated as described in Example 2.

As shown in FIG. 3, both VIC-007 and VIC-008 significantly enhanced the survival of tumor-bearing mice compared to saline (p=0.0253 and p=0.0002), with increased median survival of 55 days from saline to 60 days from VIC-007 and further to 65 days from VIC-008. VIC-008 further significantly prolonged the survival of the tumor-bearing mice compared to VIC-007 (p=0.0301). Survival was analyzed with the Log-rank test.

Taken together, these data showed that the new version of the fusion protein VIC-008 significantly delayed the tumor growth and prolonged the survival in a syngeneic murine model of ovarian cancer. Improved mouse survival of VIC-008 compared to VIC-007 is likely related to the changes made to the protein sequences.

Example 4. Combination Treatment of VIC-008 with AMD3100 Further Prolongs Mouse Survival

Mesothelioma tumor was established by i.p, injection of cancer cells, Luc-40L or Luc-AE17, into C57BL/6 mice. One week later, saline, VIC-008 (20 μg), and/or AMD3100 (1 μg/g body weight) were administered once a week for four weeks, as indicated in FIG. 4.

As shown in FIG. 5 (Luc-40L), VIC-008 significantly enhanced the survival of tumor-bearing mice compared to saline (p=0.0214), while the combination of VIC-008 and AMD3100 further enhanced survival (p<0.0001 versus saline). Similar results were observed with Luc-AE17 (FIG. 6). AMD3100 had a slight effect on survival, but this effect did not reach significance in this study.

These data show that VIC-008 alone is able to prolong survival in both models of mesothelioma, and AMD3100 alone slightly benefits survival. Combination treatment with VIC-008 and AMD3100 significantly suppresses mesothelioma proliferation and prolongs survival of mice with mesothelioma tumors.

Example 5. Combination Treatment of VIC-008 with AMD3100 For Mesothelioma Materials and Methods Reagents

The fusion proteins were constructed as described above and expressed by WuXi Biologics (Shanghai, China) in CHO cells and provided at a purity of above 95% by HPLC and an endotoxin level of less than 1.0 EU/mg. AMD3100 was purchased from Abcam (#ab120718).

Tumor Cells

40L and AE17 mouse mesothelioma cell lines were kind gifts from Dr. Agnes Kane in Department of Pathology and Laboratory Medicine at Brown University. Cells were cultured at 37° C. in DMEM supplemented with 1% L-glutamine, 1% penicillin-streptomycin, and 10% fetal bovine serum.

Animal Models

Five-week-old female C57BL/6 mice were obtained from the Jackson Laboratory and maintained in the gnotobiotic animal facility of Massachusetts General Hospital (MGH) in compliance with institutional guidelines and policies. After one week acclimatization, tumors were initiated with 4×10⁶ 40L cells or 2×10⁶ AE17 cells per mouse administered intraperitoneally (i.p.). A subset of the mice from each group were euthanized with i.p. administration of Ketamine (9 mg/ml in saline) and Xylazine (0.9 mg/ml in saline) 7 days after the last treatment, and samples harvested for immune profiling of tumors, lymph nodes and spleens. The remaining animals in each group were monitored for survival. For survival studies, the mice were observed daily after inoculation of tumor cells. Tumor generation was consistently first evident via the appearance of abdominal distension secondary to malignant ascites, and tumor-bearing mice were euthanized at the endpoint when there were signs of distress, including fur ruffling, rapid respiratory rate, hunched posture, reduced activity, and progressive ascites formation.

Splenocytes from transgenic T-Red/FoxP3 GFP mice were used as a source of fluorescently tagged T_(reg) cells by cell sorting as described below. T-Red/FoxP3 GFP mice are a fully backcrossed C57BL/6 line of transgenic mice that produced by crossing T-red mice with FoxP3 GFP mice. T-red mice express dsRedII under the control of the CD4 promoter modified to lack the negative control element thereby allowing expression in both CD4⁺ and CD8⁺ T cells. In FoxP3 GFP mice, GFP is expressed from under control of the FoxP3 promoter with internal deletions to FoxP3 to prevent over expression. All animal studies were approved by the Institutional Animal Care and Use Committee of MGH.

Treatment

Beginning seven days after tumor inoculation, treatments were administrated by i.p. injection once a week for four successive weeks. VIC-008 was administrated i.p. at 20 μg in 100 μl of saline per mouse once a week and AMD3100 was given once a week by i.p. injection at 1 mg/kg of body weight in 100 μl of saline.

Immune Profiling by Flow Cytometry

Tumors were mechanically disaggregated using sterile razor blades and digested at 37° C. for 2 hours in RPMI 1640 with collagenase type IV for 40L, tumors or type I for AE17 tumors (2 mg/ml, Sigma), DNase (0.1 mg/ml, Sigma), hyaluronidase (0.1 mg/ml, Sigma), and BSA (2 mg/ml, Sigma). Cell suspensions were passed through 100 μm filters to remove aggregates. Lymph nodes and spleens were mashed and filtered through 40 μm strainers. Cells were washed with staining buffer (#420201, Biolegend) and stained with the conjugated antibodies for surface markers. Total live cells were determined by LIVE/DEAD® staining (ThermoFisher, #L23105).

For intracellular cytokine detection, after staining of surface markers, cells were fixed and permeabilized with fixation/permeabilization reagents from BioLegend (#424401) or eBioscience (#00-5521-00) and stained with the conjugated antibodies for intracellular markers.

Conjugated antibodies from eBioscience were as follows: CD40L (clone MR1), and PD-1 (clone J43). The following conjugated antibodies were purchased from BioLegend: CD3 (clone 17A2), CD4 (clone GK1.5), CD8a (clone 53-6.7), Foxp3 (clone MF-14), IL-2 (clone JES6-5H4), and IFN-γ (clone XMG1.2). CD25 (clone PC61) antibody was from BD Biosciences.

Flow cytometric analyses were performed using BD LSRFortessa X-20 (BD Biosciences). Gating strategies were determined by the Fluorescence Minus One. Flow data were analyzed by FlowJo V 10 (TreeStar).

Ex-Vivo Culturing of Splenocytes and Cytokine Detection

The splenocytes were harvested from mashed spleens, filtered through 40 μm cell strainers and treated with red blood cell lysis buffer. 2×10⁶ splenocytes were placed per well in 24-well plates in RPMI 1640 medium supplemented with L-glutamine and stimulated with 2 μg/ml of recombinant mouse mesothelin (BioLegend, #594006) for 72 hours. Brefeldin A and Monesin (BioLegend, #420601 and #420701) were added into the culture medium during the last five hours. Splenocytes were then harvested and intracellular cytokine staining performed using the corresponding antibodies for cytometric analysis.

In Vitro Reprogramming of T_(reg) Cells

rGH-ffLuc-eGFP transgenic mice express Green Fluorescent Protein (GFP) in Foxp3⁺ T_(reg) cells. Spleens were collected from these mice and mashed and filtered through 40 μm strainers. Cells expressing GFP-Foxp3 from CD4⁺ splenocytes were sorted on a FACSAria (BD Biosciences) and then exposed to AMD3100 (5 μg/ml) in the presence or absence of anti-CD3/CD28 antibody (1 sg/ml) for 24 hours. Brefeldin A and Monesin (BioLegend, #420601 and #420701) were added into the culture medium during the last five hours. The cells were then harvested and stained with the conjugated antibodies specific for CD3, CD4, CD25, Foxp3, IL-2 and CD40L, and analyzed by flow cytometry.

Statistical Analyses

P values were calculated by GraphPad Prism 6. Unless described otherwise, the P values for comparison among groups were obtained by One-way ANOVA with Dunnett's multiple comparisons test or unpaired t-test with Welch's correction. The Kaplan-Meier method and log-rank test were used to compare survival among groups. P<0.05 is considered statistically significant. Data are presented as mean±SEM.

Results

Combination Therapy with AMD3100 and VIC-008 Augments Tumor Control and Mouse Survival

Two intraperitoneal malignant inesothelioma models were established in immunocompetent C57BL/6 mice, separately using the syngeneic 40L and AE17 cell lines. Here, the effect of AMD3100 and VIC-008 was tested, used singly or in combination, on tumor growth and animal survival in mesothelioma-bearing mice. In animals treated with VIC-008 alone (20 μg per mouse), the total weight of intraperitoneal tumors collected one week after the last treatment was generally reduced (FIGS. 7A-7B) and animal survival was significantly prolonged (FIGS. 7C-7D) compared to saline control treatment in both the 401L and AE17 models (P<0.01 and P<0.01, respectively). AMD3100 alone at 1 mg/kg of mouse body weight conferred only modest benefit to survival in both 40L and AE17 mouse MM models compared to saline control treatment. However, the combination treatment with VIC-008 and AMD3100 significantly enhanced tumor control (P<0.0001 and P<0.001, respectively) and prolonged animal survival (P<0.0001 and P<0.0001, respectively) compared to saline control in both 40L and AE17 models. Moreover, the combination treatment showed further significantly improved antitumor efficacy on inhibition of tumor growth (P<0.001 and P<0.05, respectively) and prolongation of mouse survival (P<0.0001 and P<0.001, respectively) compared to VIC-008 monotherapy in both 40L and AE17 models. These data indicate that when combined, AMD3100 significantly enhances the antitumor effect of VIC-008 in both 40L and AE17 MM mouse models compared to monotherapy with either agent.

VIC-008 Increases Lymphocyte Infiltration in Spleens, Lymph Nodes and Tumors

Spleens, axillary and inguinal lymph nodes, and intraperitoneal tumors were collected from tumor-bearing mice one week after the last treatment. Single cells were prepared from these tissues and analyzed by flow cytometry (FIG. 8A). The proportions of CD8⁺ T cells in the total live cells recovered from spleens (P<0.05 and P<0.05, respectively) and tumors (P<0.01 and P<0.01, respectively) for both the 40L. and AE17 models, and from lymph nodes (P<0.01) in AE17 model were significantly increased in the VIC-008 treatment group compared to that in the saline control group (FIGS. 8B-8F). In VIC-008 and AMD3100 combination treatment group, the proportions of CD8⁺ T cells in the total live cells recovered from spleens (P<0.05 and P<0.05, respectively) and tumors (P<0.01 and P<0.05, respectively) for both the 40L and AE17 models, and from lymph nodes (P<0.001) in AE17 model were significantly increased compared to that in the saline control group. AMD3100 treatment did not increase the proportion of CD8⁺ T cells in these tissues. Moreover, there was no difference in the proportion of CD8⁺ T cells between the VIC-008 and combination treatment groups, indicating that VIC-008 increased lymphocyte infiltration of these tissues.

VIC-008 Enhances Tumor Antigen-Specific CD8⁺ T-Cell Responses

Next, single cells isolated from spleens and lymph nodes from tumor-bearing mice were restimulated with recombinant mesothelin ex vivo and analyzed intracellular IFN-γ in CD8⁺ T cells. Mesothelin-specific IFN-γ expression in splenic CD8⁺ T cells both in 40L (P<0.001) and AE17 (P<0.001) models, and in lymph node CD8⁺ T cells in the AE17 model (P <0.01), were significantly greater in mice treated with VIC-008 alone compared to that in mice treated with saline (FIGS. 9A-9D). In VIC-008 and AMD3100 combination treatment group, mesothelin-specific IFN-γ expression in splenic CD8⁺ T cells both in 40L (P<0.01) and AE17 (P<0.01) models, and in lymph node CD8⁺ T cells in the AE17 model (P<0.001), were significantly greater compared to that in mice treated with saline. AMD3100 treatment by itself did not enhance antigen-specific IFN-γ secretion in CD8⁺ T cells. Together, these data support the view that VIC-008 treatment enhances antitumor CD8⁺ T-cell responses in both the 40L and AE17 mesothelioma mouse models.

AMD3100 Decreases PD-1 Expression on CD8⁺ T Cells

Next, expression of programmed cell death protein-1 (PD-1) on CD8⁺ T cells was evaluated in spleen, tumor and lymph nodes. There was no significant difference between the VIC-008 treatment group and the saline control group in the proportion of P1-1-expressing CD8⁺ T cells in spleens in both the 40L and AE17 tumor-bearing mice, and in lymph nodes for AE17 mice (FIGS. 10A-10C). In marked contrast, significantly more intratumoral CD8⁺ T cells in the VIC-008 treated group expressed PD-1 in the 40L tumors (P<0.05) and AE17 tumors (P<0.01) compared with the saline-treated controls (FIGS. 10D-10E). The percentage of PD-1 expressing CD8⁺ T cells ranged between 43-76% and 28-47% in the 40L tumors and AE17 tumors respectively compared to only 5-10% in spleen and lymph nodes. These data indicate that the antitumor activity of the CD8⁺ T cells in the tumor environment induced by VIC-008 treatment could be obstructed by activation of the PD-1/PD-L1 pathway.

Compared to this effect of VIC-008, and surprisingly, it was found that AMD3100 reduced PD-1 expression on CD8⁺ T cells. AMD3100 treatment alone led to significantly fewer PD-1-expressing CD8⁺ T cells in spleens (P<0.05 and P<0.01, respectively) and tumors (P<0.05 and P<0.05, respectively) in both the 40L and AE17 tumor-bearing mice, and in lymph nodes (P<0.01) for AE17 mice than in mice treated with saline. In AMD3100 and VIC-008 combination treatment group significantly fewer CD8⁺ T cells expressed PD-1 in spleens (P<0.05 and P<0.01, respectively) and tumors (P<0.05 and P<0.05, respectively) in both the 40L and AE17 tumor-bearing mice, and in lymph nodes (P<0.01) for AE17 mice compared with the saline-treated controls. There was no significant difference in the proportion of PD-1-expressing CD8⁺ T cells in these tissues between the AMD3100 monotherapy and AMD3100-VIC-008 combination therapy groups. These data indicated that AMD3100 could inhibit CD8⁺ T cells from expressing PD-1 in spleens, lymph nodes and tumors.

AMD3100 Reduces Tumor-Infiltrating T_(reg) Cells

Next, the impact of AMD3100 on T cells was evaluated. AMD3100 did not alter the proportions of T_(reg) cells found in spleens of 40L tumor-bearing mice (FIGS. 11A-11B). In AE17 tumor-bearing mice AMD3100 alone generally reduced T_(reg) in the lymph nodes (FIG. 11C) and AMD3100 alone or in combination with VIC-008 significantly increased the cell ratio of CD8⁺ T cells to T_(reg) cells (P<0.01 and P<0.0001, respectively) compared to saline treatment (FIG. 11D). In tumors from both the 40L and AE17 models, AMD3100 applied as monotherapy significantly decreased the proportions of T_(reg) (P<0.05 and P<0.01, respectively) and increased the ratio of CD8⁺ T cells to T_(reg) (P<0.001 and P<0.01, respectively) compared to saline treatment (FIGS. 11E-11F). In AMD3100 and VIC-008 combination treatment group the proportions of T_(reg) were significantly decreased (P<0.05 and P<0.05, respectively) and the ratio of CD8⁺ T cells to T_(reg) increased (P<0.001 and P<0.0001, respectively) compared to saline treatment in both the 40L and AE17 models. In these two murine mesothelioma models, AMD3100 reduced intratumoral T_(reg) infiltration.

AMD3100 Modulates T_(reg) Cells Toward a T Helper Phenotype

It was observed that AMD3100, alone or in combination with VIC-008, significantly increased the ratio of CD25⁻ cells to CD25⁺ cells within the Foxp3⁺ population in both 40L (FIG. 12A, P<0.01 and P<0.001, respectively) and in the lymph nodes in the AE17 model (FIG. 12B, P<0.001 and P<0.01, respectively). Among the Foxp3⁺ CD25⁻ T_(reg) population significantly more cells were phenotypically IL-2⁺ CD40L⁺ (FIGS. 12C-12E) after AMD3100 monotherapy and combination therapy with VIC-008, which suggested a change from T_(reg) cells to helper-like cells that had lost CD25 without loss of Foxp3, and may have lost their immunosuppressive function. There was no difference in the proportion of IL-2⁺ CD40L⁺ cells in the Foxp3⁺ CD25⁻ T_(reg) population between AMD3100 monotherapy and combination therapy groups, indicating that AMD3100 treatment may be the major driver of reprogramming of T_(reg) into helper-like cells.

AMD3100-Driven Modulation of T_(reg) Phenotype Requires TCR Activation

It was next addressed whether AMD3100-driven T_(reg) modulation could be initiated in isolated single cells. Cells expressing GFP-Foxp3 from CD4⁺ splenocytes in T-Red/FoxP3 GFP transgenic mice were sorted and treated in vitro with AMD3100. AMD3100 treatment alone did not change the ratio of the proportion of CD25⁻ cells to CD25⁺ cells in the Foxp3⁺ CD4⁺ population (FIGS. 13A-13B). However, in the presence of stimulation by anti-CD3/CD28 antibodies to trigger TCR activation, AMD3100 treatment significantly increased the ratio of the proportion of CD25⁻ cells to CD25⁺ cells in the Foxp3CD4⁺ population (FIGS. 13C-131), P=0.0017) and converted more Foxp3⁺ CD25⁻ T_(reg) into IL-2⁺ CD40L⁺ cells (FIGS. 13E-13F, P=0.0015). These data indicated that the conversion of T_(reg) cells into helper-like cells can be mediated by AMD3100 treatment of single cells upon TCR activation.

The foregoing is illustrative of the present invention, and is not to be construed as limiting thereof. The invention is defined by the following claims, with equivalents of the claims to be included therein. 

What is claimed is:
 1. A method for treating a cancer in a patient in need thereof, wherein said cancer expresses chemorepellant properties, the method comprising administering to the patient a) an effective amount of a fusion protein which fusion protein comprises a cancer cell binding component and a stress protein component, wherein said cancer cell binding component binds to the cancer cell and said stress protein component activates dendritic cells, leading to the generation of CD3 positive T-cells that target cancer antigens; and b) concurrently administering to said patient an effective amount of an anti-chemorepellant agent; wherein the combination of the fusion protein and the anti-chemorepellant agent treat the cancer.
 2. The method of claim 1, wherein the anti-chemorepellant agent is selected from the group consisting of AMD3100 or a derivative thereof, AMD11070, AMD12118, AMD11814, AMD13073, FAMD3465, C131, BKT140, CTCE-9908, KRH-2731, TC14012, KRH-3955, 3MS-936564/MDX-1338, LY2510924, GSK812397, KRH-1636, T-20, T-22, T-140, TE-14011, T-14012, TN14003, TAK-779, AK602, SCH-351125, tannic acid, NSC 651016, thalidomide, GF 109230X, an antibody that interferes with dimerization of a chemorepellant chemokine, and an antibody that interferes with dimerization of a receptor for a chemorepellant chemokine.
 3. The method of claim 2, wherein the anti-chemorepellant agent is AMD3100.
 4. The method of any one of claims 1-3, wherein the stress protein is HSP70 or an immune activating fragment and/or modified sequence thereof.
 5. The method of claim 4, wherein the HSP70 or the immune activating fragment and/or modified sequence thereof is from Mycobacterium tuberculosis.
 6. The method of any one of claims 1-5, wherein the cancer cell binding component is a single chain antibody, a variable domain, or a Fab domain.
 7. The method of any one claims 1-6, wherein the fusion protein comprises a peptide having at least 85% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.:
 2. 8. The method of claim 7, wherein the fusion protein comprises the peptide sequence of SEQ ID NO.:
 2. 9. The method of any one of claims 1-8, wherein the anti-chemorepellant agent and the fusion protein are co-administered.
 10. The method of any one of claims 1-8, wherein the anti-chemorepellant agent is administered prior to administration of the fusion protein.
 11. The method of any one of claims 1-8, wherein the anti-chemorepellant agent is administered after administration of the fusion protein.
 12. The method of any one of claims 1-11, wherein the cancer cell binding component is specific for a protein selected from the group consisting of mesothelin, alphafetoprotein, CEA, CA-125, MUC-1, Her2Neu, ETA, NY-ESO-1, VEGF, VEGFR1, VEGFR2, PSMA, prostate specific antigen, HPV17E7, mutant p53, surviving, ras, MAGE, gp100, tyrosinase, WT1, PR1, folate-binding protein, CA-19-9, FAP, G250, and A33.
 13. The method of claim 12, wherein the antibody is specific for mesothelin.
 14. The method of any one of claims 1-13, wherein the cancer comprises mesothelioma, breast cancer, head and neck cancer, leukocytic cancer, liver cancer, ovarian cancer, bladder cancer, prostatic cancer, skin cancer, bone cancer, brain cancer, leukemia cancer, lung cancer, colon cancer, anal cancer, CNS cancer, melanoma cancer, renal cancer, cervical cancer, esophageal cancer, testicular cancer, splenic cancer, kidney cancer, lymphatic cancer, pancreatic cancer, stomach cancer, leukemia, lymphoma, myeloma, a gastrointestinal cancer, or thyroid cancer.
 15. The method of any one of claims 1-14, wherein the cancer expresses mesothelin.
 16. The method of any one of claims 1-15, wherein the fusion protein is administered via injection.
 17. The method of claim 16, wherein the fusion protein is injected directly into a tumor.
 18. The method of any one of claims 1-17, wherein the anti-chemorepellant agent is administered via injection.
 19. A pharmaceutical composition comprising a fusion protein and an anti-chemorepellant agent, said fusion protein comprising a cancer cell binding component and a stress protein component.
 20. The composition of claim 19, further comprising antigen-presenting cells.
 21. The composition of claim 20, wherein the antigen-presenting cells are dendritic cells.
 22. The composition of any one of claims 19-21, wherein the anti-chemorepellant agent is selected from the group consisting of AMD3100 or a derivative thereof, AMD11070, AMD12118, AMD11814, AMD13073, FAMD3465, C131, BKT140, CTCE-9908, KRH-2731, TC14012, KRH-3955, BMS-936564/MDX-1338, LY2510924, GSK812397, KRH-1636, T-20, T-22, T-140, TE-14011, T-14012, TN14003, TAK-779, AK602, SCH-351125, tannic acid, NSC 651016, thalidomide, GF 109230X, an antibody that interferes with dimerization of a chemorepellant chemokine, and an antibody that interferes with dimerization of a receptor for a chemorepellant chemokine.
 23. The composition of claim 22, wherein the anti-chemorepellant agent is AMD3100.
 24. The composition of any one of claims 19-23, wherein the stress protein is HSP70 or an immune activating fragment and/or modified sequence thereof.
 25. The composition of claim 24, wherein the HSP70 or the immune activating fragment and/or modified sequence thereof is from Mycobacterium tuberculosis.
 26. The composition of any one of claims 19-25, wherein the cancer cell binding component is a single chain antibody, a variable domain, or a Fab domain.
 27. The composition of any one of claims 19-26, wherein the cancer cell binding component is specific for a protein selected from the group consisting of mesothelin, alphafetoprotein, CEA, CA-125, MUC-1, Her2Neu, ETA, NY-ESO-1, VEGF, VEGFR1, VEGFR2, PSMA, prostate specific antigen, HPV17E7, mutant p53, surviving, ras, MAGE, gp100, tyrosinase, WT1, PR1, folate-binding protein, CA-19-9, FAP, G250, and A33.
 28. The composition of claim 27, wherein the antibody is specific for mesothelin.
 29. The composition of claim 28, wherein the fusion protein comprises a peptide having at least 85% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.:
 2. 30. The composition of claim 29, wherein the fusion protein comprises the peptide sequence of SEQ ID NO.:
 2. 31. The composition of any one of claims 19-30 which is formulated for injection.
 32. The composition of any one of claims 19-31, further comprising a pharmaceutically acceptable excipient.
 33. A kit of parts for treatment of a cancer in a patient, the kit comprising a therapeutically effective amount of an anti-chemorepellant agent and a fusion protein comprising a cancer cell binding component and a stress protein component, wherein the cancer cell binding component recognizes an antigen expressed by the cancer.
 34. The kit of parts of claim 33, wherein the anti-chemorepellant agent is selected from the group consisting of AMD3100 or a derivative thereof, AMD11070, AMD12118, AMD11814, AMD13073, FAMD3465, C131, BKT140, CTCE-9908, KRH-2731, TC14012, KRH-3955, BMS-936564/MDX-1338, LY2510924, GSK812397, KRH-1636, T-20, T-22, T-140, TE-14011, T-14012, TN14003, TAK-779, AK602, SCH-351125, tannic acid, NSC 651016, thalidomide, GF 109230X, an antibody that interferes with dimerization of a chemorepellant chemokine, and an antibody that interferes with dimerization of a receptor for a chemorepellant chemokine.
 35. The kit of parts of claim 33, wherein the anti-chemorepellant agent is AMD3100.
 36. The kit of parts of any one of claims 33-35, wherein the stress protein is HSP70 or an immune activating fragment and/or modified sequence thereof.
 37. The kit of parts of claim 36, wherein the HSP70 or the immune activating fragment and/or modified sequence thereof is from Mycobacterium tuberculosis.
 38. The kit of parts of any one of claims 33-37, wherein the cancer cell binding component is a single chain antibody, a variable domain, or a Fab domain.
 39. The kit of parts of any one of claims 33-38, wherein the fusion protein comprises a peptide having at least 85% sequence homology to the peptide sequence of SEQ ID NO.: 1 or SEQ ID NO.:
 2. 40. The kit of parts of claim 39, wherein the fusion protein comprises the peptide sequence of SEQ ID NO.:
 2. 41. The kit of parts of any one of claims 33-40, wherein the fusion protein and/or the anti-chemorepellant agent are formulated for injection.
 42. The kit of parts of any one of claims 33-41, wherein the fusion protein and the anti-chemorepellant agent are in the same formulation.
 43. The kit of parts of any one of claims 33-42, further comprising instructions for treating the cancer. 